Biondo et al developed a Left Colonic Peritonitis Severity Score (PSS) to evaluate peritonitis following perforating lesions of the left colon. The score correlates with survival and can be used to compare outcomes for different patients. The authors are from the University of Barcelona in Spain.
Parameters for score identified by multivariate analysis:
(1) age
(2) ASA grade
(3) preoperative organ failure
(4) immunocompromised status
(5) ischemic colitis
(6) peritonitis stage
|
Parameter |
Odds Ratio |
95% Confidence Interval |
|
age > 70 years (vs <= 70) |
1.08 |
0.29 – 4.02 |
|
ASA score III (vs I-II) |
4.10 |
0.89 – 18.96 |
|
ASA score IV (vs I-II) |
18.67 |
2.70 – 129.01 |
|
ischemic colitis (vs other) |
4.58 |
0.59 – 35.15 |
|
peritonitis grade 3-4 (vs 1-2) |
2.50 |
0.57 – 10.81 |
|
preoperative organ failure |
9.38 |
2.16 – 40.62 |
|
immunocompromised status |
2.63 |
0.42 – 16.24 |
|
Parameter |
Finding |
Points |
|
age in years |
<= 70 |
1 |
|
|
> 70 |
2 |
|
ASA grade |
I |
1 |
|
|
II |
1 |
|
|
III |
2 |
|
|
IV |
3 |
|
preoperative organ failure |
none |
1 |
|
|
1 or more organs |
3 |
|
immunocompromised status |
no |
1 |
|
|
yes |
2 |
|
ischemic colitis |
no |
1 |
|
|
yes |
2 |
|
peritonitis stage |
I (pericolic abscess) or II (pelvic abscess) |
1 |
|
|
III (purulent peritonitis) or IV (fecal peritonitis) |
2 |
where:
• Peritonitis stage is after Hinchey et al. Adv Surg. 1978; 12: 85-109.
left colon peritonitis severity score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 6
• maximum score: 14
• The higher the score the greater the mortality rate.
|
Prognostic Score |
Mortality Rate |
|
6 |
0% |
|
7 |
3% |
|
8 |
25% |
|
9 |
30% |
|
10 |
60% |
|
11 |
65% |
|
12 |
65% |
|
13 or 14 |
100% |
estimated from Figure 1, page 640
where:
• Scores of 8 and 9 give similar mortality rates, as do 10, 11 and 12. It may be possible to combine scores to 5 levels (scores 6, 7, 8-9, 10-12, 13-14).
Purpose: To evaluate a patient with peritonitis following left colonic perforation using the peritonitis severity score of Biondo et al.
Specialty: Infectious Diseases, Surgery, general, Gastroenterology
Objective: severity, prognosis, stage
ICD-10: K65,
